Diabetes Impairs Walking Capacity And Autonomic Function In Patients With Peripheral Artery Disease

Abstract

Diabetes is a high prevalent comorbid condition in patients with peripheral arterial disease (PAD). Previous studies showed that diabetes impair physical function in PAD patients. However, whether cardiovascular function is also affected by diabetes is unknown. PURPOSE: To compare walking capacity and cardiovascular function in PAD patients with and without diabetes. A total of 80 patients (n=41 non-diabetic and n=39 diabetic) with PAD were recruited. Six-minute walk test (total walking capacity), 4-meter test, walking impairment questionnaire (WIQ) and the walking estimated-limitation calculated by history (WELCH) were used to assess walking capacity. Cardiovascular function was assessed by blood pressure, arterial stiffness, heart rate variability and flow-mediated dilation. Mann-Whitney U test were performed, and data are presented in median and interquartile range. RESULTS: Diabetic PAD patients presented lower total walking capacity (308 ± 120 m vs. 370 ± 125m, p=0.025), WIQ distance score (10 ±23 vs. 30 ±46, p=0.002), WIQ speed score (17 ± 21 vs. 28 ± 27, p=0.001), WIQ stairs score (21 ± 42 vs. 42 ± 42, p=0.024), WELCH total score (20 ± 26 vs. 40 ± 42, p=0.006) compared to non-diabetic PAD patients. In addition, diabetic PAD patients had lower SDNN (22 ± 21 vs. 29 ± 36, p=0.030), and a trend to have lower RMSSD (13 ± 19 vs. 19 ± 32, p=0.061), and PNN50 (0.4 ± 3.7 vs. 1.6 ±21.0, p=0.072). The remaining variables were similar between PAD patients with and without diabetes. CONCLUSION: Diabetes impairs walking capacity and cardiac autonomic modulation in patients with PAD. Therefore, interventions to improve these parameters should be emphasized in diabetic PAD patients. Supported by FAPESP (# 2016/16425-9) and CNPq (#310508/2017-7)